What If Everything You Know About Anxiety Is Wrong?

By Annabelle Parr, MA, AMFT

When we experience anxiety, our minds are really good at coming up with all kinds of “what if” thoughts. And those worried thoughts often deal in extremes and absolutes, like the title of this post.  

Good news: it’s unlikely that everything you know about anxiety is wrong.

If you’ve ever experienced anxiety, at the very least you know what it feels like in your mind and your body. But it is possible that some of what you’ve learned about anxiety is not workable (that is, it doesn’t move you toward the kind of life you want to live).

Anxiety in the information age:

These days, the internet is filled with articles and podcasts discussing stress, anxiety, and self-care. It is so important to make information accessible and to talk openly about the difficult and painful parts of being a human. When we are suffering, knowing that we are not alone in our experience can make all the difference.

As much as it is wonderful that these topics are getting so much air time, the way we talk about them matters.

As anxiety is a rather hot topic these days, we decided to bust some of the common myths that, though well intentioned, can actually keep us stuck.

Myth #1: You can self-care your way out of anxiety.

There is a fair amount of content out there that sends the message that if you just take enough bubble baths, do enough yoga, or drink enough herbal tea, your anxiety will finally go away. Or that if you’re ever going to get a handle on your anxiety, you have to eat healthy, get good sleep, and exercise regularly. None of those activities are bad or wrong, and they can help us feel good.

But when we engage in a behavior (ANY behavior – even “healthy” behaviors) where the purpose is to control or avoid our internal experience, we may paradoxically find ourselves even more stuck. Our anxiety might go away momentarily, but we may find that in the long term (or even in the middle of downward dog) our anxiety actually gets more powerful. And then when anxiety doesn’t go away, we think that we are doing self-care wrong, or worse, that there is something wrong with us since it’s not working. Cue cycle of chugging herbal tea and feeling anxious about the fact that we are still feeling anxious. 

Myth #2: If you just got the hang of positive thinking, you’d be anxiety-free.

If positive thinking works for you, helps you cope, and allows you to be the person you most want to be, carry on. But if it doesn’t, you are not alone. When I am at my most anxious or upset, trying to convince myself to believe a more positive thought often makes me feel worse. I might be able to come up with a more positive thought, but then I just feel frustrated that I can’t make myself believe it. Research supports that trying to suppress our thoughts can actually increase the frequency and intensity of the very thought we are trying to avoid.  

While traditional Cognitive Behavioral Therapy works on helping people to engage in more balanced thinking (NOT unrealistically optimistic positive thinking), Acceptance and Commitment Therapy can help us change our relationship to our thoughts. Our thoughts, after all, are just words. Sometimes they have helpful information to share, but they aren’t always great at communicating it to us. 

Myth #3: You need your anxiety to go away before you can do the things that matter to you.

Anxiety is good at convincing us that we can’t or shouldn’t do things that matter to us until we feel less anxious. But the best antidote to anxiety is doing what matters to you even when anxiety is at its loudest. Because here’s the thing: anxiety typically shows up around the things that you care most about. So if you wait for anxiety to go away before you go after the life you want or before you show up as the kind of person you want to be, you may end up waiting forever.

So is your anxiety coping skills toolkit workable?

Workable simply means: does this behavior help you move in the direction of your values (who and how you want to be in the world) and does it have a cost to you? So if you have a stellar self-care routine that helps you feel more present, engaged and able to show up in your life as the person you want to be, keep doing your thing. And if positive thinking has helped you live a more meaningful, fulfilling life, keep it up.

But if you find that you are trying to control your anxiety and make it go away, and instead it just keeps getting more powerful, more intense, and more uncomfortable as your life gets smaller and more restricted, Acceptance and Commitment Therapy (ACT) may help. ACT is designed to help you change your relationship to anxiety and help you develop psychological flexibility: the ability to do what matters to you no matter what.

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.

A Lesson on Living Life to Its Fullest

by Shoshana Shea, Ph.D.

“You must defeat your reason before you can start” – Patrick Star

If you want to live life to the fullest, it’s not about forgetting all your troubles and checking out, it’s about slowing down, checking in, and recognizing you have choices. One of the greatest examples of this came from the imagination of Stephen Hillenburg, “SpongeBob Squarepants” show creator, and his writers. The character is Larry the Lobster; the name of the episode, “A Life in a Day.” As I watched that episode for the 100th time, I was thinking more about Larry’s secret to living life to the fullest; he pronounces, “You got to take risks. Live on the edge…by living each day like it was your last.” Larry goes on to say, “By livin’ like, me, Larry!” 

Living life to the fullest does NOT mean that we should try to ignore all our fears and worries.

Patrick The Starfish, states, “This is the moment where we redeem our miserable lives,” and decides that he must live moment to moment and find the most dangerous of feats; then he will truly be living! To Patrick, ‘Living life to the fullest’ seems to mean that we should try to forget reality and just live without regard for the long-term consequences. I think many of us can relate to that idea, that we wish to live completely free of fear and shut off our worries like a faucet. If only it were that easy! Patrick pronounces, “You must defeat your reason before you can start.” This is my absolute favorite line! It can sound so appealing to ignore that voice in our head that urges us to be cautious and go the opposite direction. But as appealing as it might sound to have no fear, as Patrick discovers, this can have pretty big consequences.

Cautious isn’t necessarily the same as stagnant or boring…

While Patrick is out thrill-seeking within inches of his life, Spongebob interprets living a full life to mean not taking any risks at all. He embodies that voice in our head that tells us to stay firmly planted inside our comfort zone. That familiar voice which can paralyze us, and which can make life stagnant, boring, and small.

Moving towards our values is not easy; otherwise we’d all be doing it!

When we are heading in a direction that is deeply meaningful to us (TOWARDS our values), we have to remember that the short-term is usually not easy at all. When we are moving AWAY from our valued direction, the short-term is usually a relief and can be enthralling at first. What we later find out is, ultimately, an AWAY move reveals that the hard stuff is still there and there are usually negative consequences to whatever method of avoidance we chose in the first place: Drinking excessively, overeating, acting impulsively, reckless thrill seeking (like Patrick), or staying well within our comfort zone (like Spongebob), etc. 

Mindfulness is a useful tool to help us move towards are values.

Mindfulness is often misunderstood to mean that we are only “allowed” to be in the present moment, and not think too much, or to not think at all, about the future. Being mindful is about non-judgmentally NOTICING and having awareness of what we are thinking, feeling, and experiencing, while we are in the present moment. For example, if we are aware that we are feeling sad about our work situation, we can notice the physiological sensations that arise, any other emotions that might be present, and any thoughts that emerge. We can make deliberate decisions about the direction of our life based on these observations. Mindfulness helps us stay the course. It can help bring us back if we have strayed or feel stuck. Contrary to Patrick’s version of “living in the moment,” it’s not about making quick, impulsive, reckless decisions and remaining cut off from our thoughts and emotions. After all, our thoughts and feelings can have really important information for us. Opposite of Patrick: Slow down.

Once we recognize thoughts that help us to move towards what’s meaningful, we have choices about our actions.

A mindfulness tool we use in Acceptance and Commitment Therapy (ACT), is to look at whether our thoughts and actions are serving the function of moving us TOWARDS our values or are they moving us AWAY from what’s most meaningful. Often life throws up some curve balls. We can decide how we are going to relate to those barriers and take action. For example, using the example from above, if we notice we are unhappy at work, we might start researching other job opportunities, setting up informational interviews, and continuing to show up to work every day (all examples of TOWARDS moves), rather than quitting the next day (an example of an AWAY move), and putting ourselves in a bad position.

What will you decide?

At the end of the episode, Patrick has convinced Spongebob that really living is about engaging in a series of dangerous acts. As they are heading towards their demise, Larry saves them, but only after they are all severely injured. Larry chides them as they are heading towards the sharp rocks, “Look guys, my advice wasn’t meant to be taken literally, I meant to live life to the fullest; not to maim yourselves!” So what will you decide? To live like Patrick and “defeat your reason before you can start;” to live like Spongebob, and not take any chances or go outside your comfort zone; or to live like Larry…where risk is absolutely encouraged but in a calculated deliberate manner?

IF YOU FIND YOURSELF STRUGGLING, FEELING STUCK, AND/OR COULD USE SOME HELP NAVIGATING YOUR FEELINGS, YOU COULD BENEFIT FROM COGNITIVE BEHAVIORAL THERAPY, ACCEPTANCE AND COMMITMENT THERAPY, MINDFULNESS, AND TELEMENTAL HEALTH SERVICES. SAN DIEGO PSYCHOTHERAPY CAN HELP. WE CAN BE CONTACTED AT 619-269-2377.

When Panic Sneaks Up and Attacks

by Annabelle Parr 

It’s a regular Thursday morning and John is driving to work along the same stretch of freeway that he drives every day. He is having a stressful week, but his mind isn’t dwelling on anything in particular. His thoughts bounce from what to make for dinner to an errand he has to run during lunch to a meeting he has this afternoon. He doesn’t feel particularly anxious.

Suddenly, his heart starts racing and his palms begin sweating. He can’t explain what is happening; it doesn’t make sense to him. First he feels confused, then he begins to worry that something is wrong. He starts to feel short of breath and then he begins to feel as if he is going to faint. Because he is driving, he is afraid that if he passes out, he will crash and die.

John doesn’t know what happened to him. He worries it may have been a heart attack, but when he goes to the doctor, he learns that it was actually a panic attack. He is confused because he didn’t feel afraid or anxious prior to the attack. His doctor explains that you don’t have to feel panic to experience a panic attack.

Our body is built to respond adaptively to danger.

At some point or another, we have all experienced the feeling that our safety is being threatened. We know what it’s like to feel consciously afraid and to feel our body physiologically preparing for danger. Our heart starts racing, our palms start sweating, our breathing gets shallow, and our muscles tense up. Our body goes into fight-flight-or-freeze mode to help us respond adaptively to whatever threat we are facing.

Panic attacks are the body’s way of trying to prepare us for an unconscious perceived threat.

Sometimes, our body responds to a threat that our conscious mind is not aware of. This is what happened in the above example. When we do not feel afraid, the physiological response itself can feel threatening and overwhelming. This exaggerated and unexplained response can result in a panic attack. Panic attacks create the feeling that your body is turning against you rather than working to help you. What may once have been an adaptive response to an external threat has morphed into what feels like a threat coming from within.

What is a panic attack?

A panic attack is defined as the abrupt onset of intense fear or discomfort that peaks within several minutes. Panic attacks can emerge from a calm state or an anxious one, making them difficult to predict. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V), a panic attack includes at least four of the following symptoms:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, light-headed or faint
9. Chills or heat sensations
10. Paresthesia (numbness or tingling sensations)
11. Derealization (feelings of unreality) or depersonalization (being detached from oneself)
12. Fear of losing control or “going crazy”
13. Fear of dying

What’s the difference between a panic attack and panic disorder?

Panic disorder can develop when a person experiences recurrent and unexpected panic attacks, and develops a persistent concern or worry about additional panic attacks or their consequences and/or significant maladaptive behavior changes related to the attacks. It is possible to experience panic attacks without having panic disorder.

Are panic attacks dangerous?

People experiencing panic attacks often end up in the Emergency Room worried they are having a heart attack. While uncomfortable and overwhelming, a panic attack itself is not dangerous. But because they can arise unexpectedly, it can feel as if they are. If we have just been on a long run or are about to give a big presentation, we know why our heart is pounding or our palms are sweating. But when our heart begins pounding and we start trembling and we can’t figure out why, these symptoms are frightening. They seem to originate within our body rather than as a response to something external.

Is it all in my head?

Absolutely not. While panic attacks are psychologically rooted, they result in a very real physiological response. And though a panic attack may seem to arise out of the blue, there is always an external trigger. Our minds detect a threat, whether consciously or not, and our body responds accordingly. A feedback loop then ensues as our mind interprets our physiological response as threatening, and our body continues to attempt to prepare us to address a threat.

If you experience a panic attack, there is nothing to be ashamed of. It’s not a sign of weakness or that you are going crazy. It’s not your fault. Though it doesn’t feel this way, a panic attack is your body trying to help protect you.

Are panic attacks permanent?

No, panic attacks do not have to be a permanent fixture in your life. Though you do not cause yourself to have a panic attack, you can learn how to prevent and manage them. Panic disorder is one of the most treatable disorders, and Cognitive Behavioral Therapy has been proven to be a highly effective form of treatment.

Cognitive Behavioral Therapy

Psychoeducation and understanding what is happening in the mind and body during a panic attack is a big part of healing. Treatment also involves examining triggers, teaching clients skills to address the acute symptoms of the attack as well as the overall stress level, and using repeated exposures. Exposure therapy incorporates an experiential piece into treatment, where the client is incrementally exposed to the feared situation and learns that they will survive.

Cognitive Behavioral Therapy can help clients to overcome the fear of panic attacks themselves, and empower them to face the situations that they may have previously avoided in order to try to prevent an attack. Clients can learn that not only will they survive a panic attack, but that they can actually move on and begin to thrive.

If you are experiencing panic attacks, avoiding situations you fear could trigger an attack (driving, crowded spaces, public speaking, etc), or find that your day to day functioning is impacted by anxiety, you could benefit from Cognitive Behavioral Therapy. Dr. Shoshana Shea can help. She can be contacted at 619-269-2377.